HomeMy Public PortalAbout10631 OLIVE ST_Sewer_2/13/1962_SADDLE 1 / / y
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768EAPPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE IMSPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County En ineer ADDRESS
-,
WILLIAM A. JENSEN, Supt of w1ding LOCALITY ,
NEAREST
OR APPLICANT TO f II.I. IN CROSS ST,
FADDRESS
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N LOT NO. L> a� OWNER e
MAIL
TRACT ADDRESS
NO.OF BLDGS.
NOW ON LOT CITY TEL. NO.
h DISTRICT NO. GROUP MAP PROQESSED BY
BK Psi
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a� P"f ION r DEPTH
STATE MANHOLE REFERENCE
hi REGISTRATION NOI"-,3, w oC COUNTY C. i. LOWER
NO. DESCR! TIO OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FRO
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. I
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELO �, _r i IL
EXT ..
CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO t' !P,C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP, NO. 2 a0B NO. () -
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 31.00
ALTER,REPAI R ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DIS AL.St' T @ $1.00 PERMIT N0,
V
LU
INDUSTRIAL
WASTE APPROVAL
CHARGES Z
T OWNER'S PERMIT CONNECTION CHARGE FEE
A6A LiaORMATION TOTAL FEE REIMBURSEMENT FEE
T ADATE A CONTRACT WITH THE HEREIN CTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGADWELLIONG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY ONEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - -- ----- - BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE REND THIS APPLICATION
AND STATE THAT THE ABOVE IS, CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE SYSTElf
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILi.SEPTIC TANKS
DESCRIBED RESID I LfR
11
SEEP PITISY LC CESSPOOLS
IGNATURE v `'J^s -' -- ..�,/.% C
OF PERMITTE _
t
" VMMATION ROBERT dao WOOD
CK.r M.C. CASH SUPERVISING MECHANICAL ENGINEER
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